Stakeholders tell RC how to improve aged care governance

Advocates have told the royal commission that combining the roles of the health department and the aged care regulator, adding regional planning, appointing a commissioner for older people and ensuring aged care boards have diverse skills are among ways to improve system governance.

The Royal Commission into Aged Care Quality and Safety called for submissions on the sector’s system governance in June.

Among those responding to the call was Professor Kathy Eagar, who is director of University of Wollongong’s Australian Health Services Research Institute.

Professor Eagar has called for the establishment of a National Aged Care Authority, which is a Commonwealth corporate entity that combines the majority of the current functions of both the Department of Health and the existing Aged Care Quality and Safety Commission.

It would report to the aged care minister and Parliament, have statutory independence and receive an annual appropriation direct from Treasury.

Professor Eagar said evidence presented to the aged care royal commission highlighted the need for fundamental reform to the structure and governance of the aged care system.

“My view is that the reforms required cannot be implemented if the current governance arrangements remain in place,” Professor Eagar said in her submission.

The roles of the proposed NACA include:

• distribution of funds to a national network of regional aged care planning and commissioning agencies
• distribution of funds to states and territories for regional aged care assessment and referral services,
•  aged care facility inspections against standards
• funding system design and monitoring of funding system performance.

Under the proposal, the regional aged care planning and commissioning agencies would undertake community consultation and engagement about the needs of older people in the region, while the aged care assessment and referral service would expand the role of Aged Care Assessment Teams to include all assessment, care planning and case management for individuals in need of aged care.

The system would also include an aged care complaints commissioner based on the roles of existing health care complaints commissioners under state and territory legislation and who is responsible for receiving, investigating, and recommending action in relation to complaints about the care of individuals and the investigation of systemic failings.

Call for commissioner for older people 

Consumer group Older Persons Advocacy Network is calling for the appointment of a commissioner for older people.

The commissioner should have the relevant statutory authority to advance the rights of older people and enforce human rights throughout aged care, health and human services sectors, OPAN said in its submission.

The commissioner should also be a strong advocate for older people, influence policy and service delivery, listen to and actively seek the views of older people to inform action and investigate complaints under the proposal.

“OPAN would argue that a commissioner for older people is the missing part of the governance of the aged care system,” OPAN’s submission said.

“The commissioner for older people can work with the ACQSC and the Australian Commission on Safety and Quality in Health Care to bring a stronger focus on the rights of older people and to provide oversight and contributions to decisions that impact on older people.”

OPAN’s other recommendations to improve aged care’s governance system include:

• aged care services that are human rights based, co-designed with older people and centred on care recipients and their families, friends and carers
• mandatory baseline and refresher training on the Charter of Aged Care Rights for all aged care staff
• extending the disability sector’s National Framework for Reducing and Eliminating the Use of Restrictive Practices to cover the aged care sector
• making the chief clinical advisor the approver of antipsychotic medications for aged care residents.

Skill-diverse board members required

Elsewhere, New South Wales community group Quality Aged Care Action Group Incorporated is calling for the boards of residential aged care organisations to include a mix of business, medical, nursing, allied health and consumer representatives.

QACAG, which currently has 65 members including aged care recipients and other older people, families and friends of aged care recipients, nurses, aged care workers and carers, aims to improve the quality of life of residential and community aged care recipients.

Board members of aged care providers are often mainly from a business background, the QACAG said in its submission.

“The recent COVID-19 outbreaks in some nursing homes have raised questions about the composition of boards and the non-inclusion of medical and health professionals and consumer representation.

“It would seem evident that good governance would depend upon a balanced approach to board membership,” QACAG’s submission said.

The QACAG also recommends:

• the transparency and regulation of all fees charged to aged care residents
• an investigation and published on the appropriateness and validity of additional services.

RC’s COVID report

The aged care royal commission handed down its special report on the COVID-19 pandemic to the Governor-General on 30 September.

The government immediately accepted the report’s six recommendations to expedite measures to protect older Australians during the pandemic including additional funding to ensure enough staff to allow residents to have more visitors and a national aged care plan for COVID-19 (read our story here).

Counsel assisting the royal commission will make its final submission to the royal commissioners  on 22-23 October, which will likely provide an indication of the recommendations in the final report due on 26 February 2021.

View the full submissions for Professor Kathy Eagar, OPAN and QACAG here.

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